Adolescent Substance Abuse - Essay Example

Ryan has been staying with his grandmother since he was born and left by his teenage mother who has never been heard from since. He was a good student until around 6th grade when he started having trouble with studies and showing change of behavior with increased avoidance tendencies and rebellion. His grandmother left him to his devices and was away on most night dancing at night clubs. Ryan is no longer in school and dropped out in the 8th grade after he said it was a waste of time and said it was time to “man up”. Ryan has been on the streets doing “miscellaneous business” as he dismissively describes it to his grandmother. He has recently developed a reluctance to go out of the house; he is disinterested in most of his routine activities. His grandmother has noted that he has changed in the last year, specifically increasing in girth around the waist, a “pot-belly”, softening voice and what she has said he called his “man-boobs”. Ryan’s grandmother is aware that Ryan may have tried drugs or even actively used but denies he is dependent on any drug and say he is just a “head-strong boy” who may be going through some stress as he becomes an adult soon. Ryan says he may have drunk over the years when the opportunity presents and reports taking different varieties of alcoholic beverages at a time. He also say he has many friends who take alcohol regularly and remembers that his grandmother has never been far from an alcoholic drink for long herself.

Ryan is a Hispanic 17 year old male. He is unmarried and comes from a low socioeconomic background. He lives with his 37 year old grandmother who semiliterate and who has never had permanent employment. Ryan was referred as a result of a probation requirement after he was recently apprehended among a rowdy group of students and found in possession of marijuana with intent to deliver. He was also drunk and admitted habitual drinking, and he was required to get counseling on drug and substance abuse. Ryan was screened for alcoholism through question using the AUDIT tool and it was found that the client is a substance-dependent user. Using CAGE questions to probe more specifically, it was found that Ryan was struggling with alcoholism from childhood and has been recently trying to avoid drinking. He noted he did not have any problem with anyone talking about his drinking and said he felt guilty because he took alcohol more than his age mates. He said he often took alcohol to kick-start some days as he had seen his grandmother do often. He confessed to taking about 4 drinks per day for as long as he can remember.

He has evident liver disease stigmata with jaundice, gynaecomastia, central-obesity and softening voice on physical examination. The laboratory liver function tests showed elevated liver enzymes and reduced serum albumin. The client said the physical image is distressing and he does not understand what is wrong. He does not feel “man-enough” and feels distraught and confused besides appearing withdrawn. On screening as assessment, the client is evidently a dependent alcohol user. The patient has developed chronic liver disease or alcoholic liver disease from liver cirrhosis. The patient is also depressed from changes physical changes associated with liver failure such as fall in androgens and consequent loss in loss of masculine for more effeminate physical attributes. The patient is at risk of developing other complication such as coagulopathies, encephalopathy and renal failure and requires at least level III placement in the ASAM criteria for clinical mitigation of substance related disorders.

The patient is in quadrant III in the locus of responsibility and will therefore require collaborative effort services and level III placement. The client has biomedical conditions and is likely to develop complications and is therefore in dimension 2 of the levels of care. The first step will be to provide the client with information from objective evidence and the risk of intoxication, sudden deterioration and withdrawal. The second step will be the involvement of the client’s collaterals that in this case include the grandmother and educating her on the situation of her grandson and the possible cause. The client will be referred to a medical specialist for treatment and management of biomedical conditions and complications resulting from prolonged underage alcohol abuse. The client is likely to have challenges with getting optimum care considering that the primary guardian is also an alcoholic. The proximity to alcohol may present challenges when trying to avoid contact even with change of other harmful relationships. The low socioeconomic status and perception of marginalization may diminish acces to good health care services due to lack of provisions such as a health insurance and funds to afford quality care.

The patient will then be assessed for underlying mental comorbidities and other disabilities given the history of the client. The patient will be advised to avoid stress and guided on how to do so within a socially supportive environment by being enrolled in a resident peer self-help social program and the initiation into self-management and recovery training to move the patient to pre-contemplation of getting in control of the problem. The patient will also be helped to realize their strength and capacity from the start in relation to life functioning such as capacity to maintain a healthy lifestyle and to modify behavior. The patient will also be helped to analyze the integrity of existing and ongoing relationships and the contingent relationships that need to be formed to promote desired patient outcomes. The client should also be started addiction medicine by an addiction medicine specialist from options such as disulfiram and or naltrexone.

The client is going to be evaluated on weekly basis based on three therapeutic levels that are targeted for the patients needs in regard to alcohol abuse and dependency that include cognition, behavior, and social network within the client’s environment. The patient needs will also be evaluated weekly for quadrant and locus of responsibility assessment. The patient level of care will also evaluated weekly to determine any changes in level of disability. The patient strengths and social support will also be evaluated weekly to assess contribution to behavior change and sustenance. The intervention will be evaluated in regard to client progress through the stages of change from pre-contemplation to maintained controlled behavior for any confirmed drug related diagnosis. The patient will also be evaluated in terms of the degree of engagement in treatment.

The plan for the next session is important and will be scheduled in a week. The patient will be notified that it will be part of continuing care and that it will be a significant step in attaining better health outcome. The patient will also be dispatched with information on the consequences of noncompliance after initiation of intervention. The client will have goals to be followed up in the next session such as the joining and active engagement in a social support program. The patient will also be notified that the next session will involve a drug test and that that will be a part of continuing care. The client will also be provided with contacts to reach the multidisciplinary team in case of any sudden deterioration before the next session.